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Individual
ANNIE JEAN CRUMBAKER
Active
Individual
ANNIE JEAN CRUMBAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15-01460
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130520019
MEDICARE
—
05
—
200734630D
—
KS
Enumeration date
04/27/2011
Last updated
10/29/2020
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